PREVENTING MISMANAGEMENT OF COMMUNITY-ACQUIRED PNEUMONIA AT AN URBAN PUBLIC HOSPITAL - IMPLICATIONS FOR INSTITUTION-SPECIFIC PRACTICE GUIDELINES

Study objectives: To assess institutional performance of key diagnosti c and therapeutic interventions and to identify areas amenable to impr ovement in the management of community-acquired pneumonia (CAP), Desig n: A chart-based retrospective study. Setting: Cook Count) Hospital, a large, urban, public teaching hospital. Patients: Adult inpatients wi th a hospital discharge diagnosis of CAP. Interventions: None, Measure ments and results: Fifty hospital admissions were reviewed. Only 25 pa tients (50%) had two specimens obtained for blood culture, and sputum was sent for Gram's stain and culture for only 11 patients (22%). Appr oximately one third of the patients had portable anterior-posterior in stead of standard posterior-anterior and lateral chest radiographs per formed. Physicians in the emergency department (ED) tended to be less likely to note the presence of multilobar infiltrates or pleural effus ions than the attending radiologists, The antibiotic regimens employed in the ED and on the inpatient wards mere widely variable. The mean t ime from hospital entry until administration of the first dose of anti biotics was 5.5 h for the 18 patients for whom treatment was initiated in the ED vs 16.1 h for the 27 patients admitted through the ED for w hom therapy was deferred until ward admission (p<0.001, Student's t te st), Conclusions: Institutional variations in the performance of basic diagnostic and therapeutic interventions for patients with CAP may be substantial. The local performance of these key processes of care sho uld be assessed to help direct the formulation of institutional practi ce guidelines for the management of CAP.